Both pediatric and adult-acquired flatfoot deformities, particularly posterior tibial tendon dysfunction (PTTD) stage II, remain difficult to treat and there is much controversy in regard to the optimal form of treatment. Patients usually present with increased pain and swelling along the medial aspect of the ankle or rearfoot. The foot generally maintains an abducted forefoot position and a decrease in the height of the medial longitudinal arch. Sometimes patients can perform a double heel raise but cannot perform a single heel raise. This signifies posterior tibial tendon pathology.